Fat Spikes

I have a question about "fat spikes". I've heard from so people that if you eat a fatty meal
like pizza, that the spike happens a few hours later, so if you bolus up front with fast insulin
(Humalog, Apidra) that BG will drop before the carbs kick in.

My daughter doesn't eat regular pizza due to celiac, and generally doesn't eat fatty meals
either (burgers, fries), but of course some meals are fatty and others are not, and we have
never in 2 years observed this so-called "fat spike".

No matter what she eats, the food always raises her BG faster than insulin, even faster than
Aprida which we have been using since July. We've never seen any situation, including a
desert of ice cream, or a gluten free pizza which still has lots of cheese, where a up-front
bolus results in a drop before the rise.

We've tried extended boluses just to experiment, and they always make matters worse -
any kind of extended bolus results in a higher rise and longer recovery time, no matter what
kind of food.

Now, I am wondering if for some reason my daughter is simply not succeptible to this, or if the
"fat spike" only happens with hugely fatty meals such as a eating an entire pizza or a 2-pound
burger with fries?

I am curious if anyone who uses a CGM has plots to show what a fat spike looks like for
something like pizza, or showing how BG looks when eating pizza then using an extended bolus.

Now, I am wondering if for some reason my daughter is simply not succeptible to this, or if the
"fat spike" only happens with hugely fatty meals such as a eating an entire pizza or a 2-pound
burger with fries?

Click to expand...

I can't answer your questions regarding cgm or extended bolus (we are MDI). I do however think that our 'fat spike' comes from a combination of fat/protein with wheat products. Manning can eat cheese with fruit or veggie without a spike, hot dog without a bun and be just fine but if we do a cheese pizza or hot dog with bun we get the spike/delay. We have even seen it with homemade chicken noodle soup made with with skinless breasts and fat free broth, I am willing to bet that if we were to leave out the noodles we would not see the spike. He will typically go low, even if we bolus after eating, we are always very conservative with a low correction because we know the food is going to digest later and WHAM we get our spike.

So maybe you do not see the spike/delay because your DD does not combine fat/protein with wheat products due to the celiac.

So maybe you do not see the spike/delay because your DD does not combine fat/protein with wheat products due to the celiac.

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That is very interesting... we started the GF diet at the same time we started the CGM, so our data is only on the GF diet.
Interested to know if others on GF diet are experiencing the fat spike (or not experiencing it).

This may not help in the least, but fat spikes over here only happen if he eats a "critical mass." One piece of pizza for example, no fat spike. 2 pieces - fat spike. A McD cheeseburger and half order of small fries. No fat spike. Whole order of small fries with that burger - fat spike. 2 tablespoons of peanut butter. Not even a movement in the BG. Several "peanut butter on a spoon" snacks in a row - massive fat spike. Not sure what critical mass is on the PB. He doesn't usually eat enough to cause a spike. But he's gone nuts a couple nights and eaten way more peanut butter than expected and had good old spikes later in the night. Same with cheese. A little cheese, ok, lots of cheese, fat spike.

So I guess that's my long way of saying that perhaps it's the amount of fat. Up to a certain point won't do much, but there may be "saturation" point that you would see that spike.

This is our issue also. We only have issues with certain brands of pizza.

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Same with us. Pizza that we make at home is not much of an issue. We see fat spikes with ANY kind of Fast Food (mostly anything involving fries and she hardly eats more than a handful) and cheesecake is a horrific offender -- good thing we only eat that once in a blue moon! For us, it's the pizza from places like Pizza Hut and Dominos etc -- you know, the kind where you show up for a birthday party and see 10 boxes sitting of it on the table next to a jug of kool-aid for the kids? LOL!

Blood sugar climbed very gradually until about 2:30 when it hit 170 with double up arrows. Her DIA is only 2 hours, so all novolog was gone at this time. We gave 2 additional units of insulin and were back in range by dinner at 5:00 ish.

ETA: For other meals during our trial we didn't see any spikes much over 150. Also, we do not usually see the "drop then rise" pattern either unless there is a lot of activity involved right after meals.

I don't have any graphs to show you because I never download the CGMS. Couldn't get Carelink to work on my Vista and never pull out the old download device. Anyway, we don't have as many fat spikes since going GF, but do still have them. In Braden it takes place about 6.5 hours later. On the CGMS, it is usually a rapid rise, many times with 2 arrows. I admit I don't devote enough time to perfecting the fat spike bolus. I do know that it seems to be both fat and protein that causes problems with Braden. Since going GF, we have less spikes both immediately and delayed. I know a lot of people have commented about spikes with GF foods since many are made from rice. We haven't had this problem. I believe whoever coined the phrase YDMV hit it dead on!

For those of you who DO experience the fat spikes on a regular basis, is it treated by
delaying the insulin, or adding to the insulin?

In other words, let's say 2 pieces of pizza are 60 carbs. Do you find that you simply
extend the 60-carb bolus, or do you bolus for the entire 60 carbs, and then need an
additional bolus a few hours later?

And if so, how big is the 2nd bolus compared with the original bolus?

Here's why I am asking... we have had a lot of nights lately where anywhere up to 12u
of extra basal is needed between midnight and 5 AM (not all at once, but 1-2 units/hour).
That would correspond to over 200 carbs, so I am pretty sure it is not any kind of delayed
absorbtion of food. It is most likely a growth phase, but I am wondering if anyone who deals
with fat spikes or delayed absorption regularly every has to give that much extra insulin.

We always have to give extra insulin. Sometimes we do really well with splitting the dose and the spike is not as dramatic. Even with a spilt (70-30) we still end up giving extra around the 4 hour mark and sometime at the 6 hour mark too. So in total we give approximately 4 extra units (I do not correct with more than 2u at a time during the night). I find the split and dosing after eating helps more with the low then with the spike. I am going to try 70-45 on the next pizza night with the hopes of eliminating the extra injections (at least 1).

I read your post on increased basal at night and the first thing that came to my mind was a spike/delay. That is what does it for us, although DS is not at the preteen age. Could be hormones for your DD especially if she is experiencing this repetitively.

Every dietician I've ever talked to said it was impossible, but it seems to me that the fat and protein in these "heavy" meals must somehow be converted to glucose and need their own insulin. For us, the spike usually peaks at 5 hours after the meal and tapers off by about 7-8 hours.

I have wondered much about the fat issue also. I wonder if it is rather that fat makes the body more insulin resistant in the hours after eating and thus what people see is a hormonal and or other type of resistance to insulin after eating fat. So it is not that you need insulin to convert fat but that you need more basal during the 12 hours post a high fat meal due to the increase in insulin resistance?? Ali

We add to the insulin AND spread some of it out. So if he ate 100g of pizza, we'd probably dose 75 carbs up front and then maybe another 40 carbs spread out over 6-8 hours. But Jack appears to be kind of weird in that he needs more up front than most kids do.

Daryl, are these spikes ONLY after high fat meals? I guess I would try it for a breakfast or a lunch this weekend and see if you have a similar spike.

Why, you may ask? Well, she is getting to that age where dawn phenomenon and our friend Symogi are coming into play. We were just warned about this at the beginning of January - and wouldn't you know - a week later - all her nighttime basal skyrocketed!

I have a question about "fat spikes". I've heard from so people that if you eat a fatty meal
like pizza, that the spike happens a few hours later, so if you bolus up front with fast insulin
(Humalog, Apidra) that BG will drop before the carbs kick in.

My daughter doesn't eat regular pizza due to celiac, and generally doesn't eat fatty meals
either (burgers, fries), but of course some meals are fatty and others are not, and we have
never in 2 years observed this so-called "fat spike".

No matter what she eats, the food always raises her BG faster than insulin, even faster than
Aprida which we have been using since July. We've never seen any situation, including a
desert of ice cream, or a gluten free pizza which still has lots of cheese, where a up-front
bolus results in a drop before the rise.

We've tried extended boluses just to experiment, and they always make matters worse -
any kind of extended bolus results in a higher rise and longer recovery time, no matter what
kind of food.

Now, I am wondering if for some reason my daughter is simply not succeptible to this, or if the
"fat spike" only happens with hugely fatty meals such as a eating an entire pizza or a 2-pound
burger with fries?

I am curious if anyone who uses a CGM has plots to show what a fat spike looks like for
something like pizza, or showing how BG looks when eating pizza then using an extended bolus.

Click to expand...

Darryl,
I suspect your daughter still has significant beta cell production left. That's pretty much my theory on why some kids don't have as much problem with food absorption. You had once told me her basal rates and they were super low, which gives me the idea that she is still significantly honeymooning.

I also feel that people that do well on one basal rate (ie Lantus) probably also have some good beta and alpha cell function left. It is incredibly difficult to manage diabetes with a child that has no beta or alpha cell function left, and I believe food absorption is much more prominent a problem because the body has absolutely no ability to take care of glucose on it's own.

Daryl, are these spikes ONLY after high fat meals? I guess I would try it for a breakfast or a lunch this weekend and see if you have a similar spike.

Click to expand...

No... they tend to happen every night for about a week, then subside a few days,
then return again. She doesn't eat fatty meals or meat very often, she eats mainly
low-fat for the most part as recommended by her doctor. We never have pizza,
burgers, fries, fast food, or large meat servings.

I'm not sure I'd call it a "spike" after all, as the higher basal need lasts anywhere
from 3 to 8 hours.

So, I think it must be growth related. Based on what others are saying here, I can't
see how a typical 60 carb dinner (4u) could result in the need for an extra 12u overnight!

Darryl,
I suspect your daughter still has significant beta cell production left. That's pretty much my theory on why some kids don't have as much problem with food absorption. You had once told me her basal rates and they were super low, which gives me the idea that she is still significantly honeymooning.

Click to expand...

It is possible, although she's more then 2 years since dx and while her basals used to be as low as 0.05 for days at a time up through last summer, her minimum basal has typically been 0.25 for the past 4 months and TDD has nearly tripled. So maybe this is combination of some residual beta cell function, plus growth hormones. We are planning to get a c-peptide test done at her next blood test in June, so we won't know for sure until then.

One reason I think she's not in the honeymoon phase any more is because if we give her 1 carb, BG rises 8 points, and the body does nothing about it. If there was any residual beta cell function, I'd think the beta cells could come up with 0.1u in response to the 1 carb.

I also feel that people that do well on one basal rate (ie Lantus) probably also have some good beta and alpha cell function left. It is incredibly difficult to manage diabetes with a child that has no beta or alpha cell function left, and I believe food absorption is much more prominent a problem because the body has absolutely no ability to take care of glucose on it's own.

Click to expand...

This may be true, but I'm not sure why having less insulin would delay absorbption of food... it seems that it might be the other way around, with less insulin, wouldn't BG spike faster after meals?

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